Wilbur Jane, Morrison Chloe, Bambery Luke, Tanguay Jamie, Baker Sally, Sheppard Philip, Shem Jeanine, Iakavai Judith, Poilapa Relvie, Mactaggart Islay
International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine, Keppel Street, London WCE 7HT, UK.
World Vision Vanuatu, Rue Artoi M/S, P.O Box 247, Port Vila, Vanuatu.
Lancet Reg Health West Pac. 2021 Aug 6;14:100237. doi: 10.1016/j.lanwpc.2021.100237. eCollection 2021 Sep.
Incontinence is the involuntary loss of urine and/or faeces. It is stigmatised and can reduce quality of life. People with incontinence require water, sanitation, hygiene (WASH) and incontinence products. People with disabilities are at risk of experiencing incontinence and may face challenges managing, however, minimal evidence exists.
This study aimed to complete a population-based study of disability in TORBA and SANMA Provinces, Vanuatu to quantify the prevalence and demographics of disability, experience of WASH access and incontinence for people with and without disabilities. We completed a survey, case-control study, in-depth interviews, structured observations and PhotoVoice. 179 people with disabilities and 148 people without disabilities completed the incontinence module in the case-control study. We applied purposeful sampling to select 27 people with and without a disability from the nested case-control, and 16 key informants for the qualitative study to further explore the impact of incontinence on people's lives.
People with disabilities were three times more likely to experience incontinence than people without disabilities (Adjusted Odds Ratio 3.3, 95% confidence interval 1.8 - 5.8). Challenges facing all people with incontinence were distance to latrines and lack of incontinence products. People with disabilities were less able to wash and participate in social activities. Less than 10% had assistive technologies; caregivers had no lifting devices. People experiencing incontinence did not disclose this to others, including medical professionals, who also did not raise the issue.
Inaccessible and inadequate WASH, lack of incontinence products and stigma increased isolation for all people with incontinence. Additionally, people with disabilities and caregivers faced discrimination and insufficient assistive technologies. This negatively affected their wellbeing and quality of life, and requires addressing.
Australian Government's Water for Women Fund and public donations.
大小便失禁是指尿液和/或粪便的不自主流失。它会带来污名化，还会降低生活质量。大小便失禁患者需要水、环境卫生、个人卫生（WASH）及失禁用品。残疾人有大小便失禁的风险，且在应对方面可能面临挑战，然而相关证据极少。
本研究旨在对瓦努阿图托尔巴省和桑马省的残疾情况开展一项基于人群的研究，以量化残疾的患病率和人口统计学特征，以及残疾人和非残疾人在获得水、环境卫生、个人卫生方面的经历和大小便失禁情况。我们开展了一项调查、病例对照研究、深入访谈、结构化观察和照片心声项目。在病例对照研究中，179名残疾人和148名非残疾人完成了失禁模块。我们采用立意抽样法从嵌套病例对照中选取27名残疾人和非残疾人，以及16名关键信息提供者进行定性研究，以进一步探究失禁对人们生活的影响。
残疾人大小便失禁的可能性是非残疾人的三倍（调整优势比3.3，95%置信区间1.8 - 5.8）。所有大小便失禁患者面临的挑战包括距离厕所远和缺乏失禁用品。残疾人在洗漱和参与社交活动方面能力较弱。不到10%的人拥有辅助技术；照料者没有搬运设备。大小便失禁患者不会向他人透露这一情况，包括医疗专业人员，而医疗专业人员也不会主动提及这个问题。
无法获得且不足的水、环境卫生、个人卫生条件，缺乏失禁用品以及污名化增加了所有大小便失禁患者的孤立感。此外，残疾人和照料者面临歧视且辅助技术不足。这对他们的幸福和生活质量产生了负面影响，需要加以解决。
澳大利亚政府的妇女用水基金及公众捐赠。
